Health and the Experience of Childhood

in Late Neolithic Viet Nam

MARC OXENHAM, HIROFUMI MATSUMURA, KATE DOMETT,NGUYEN KIM THUY, NGUYEN KIM DUNG, NGUYEN LAN

CUONG, DAMIEN HUFFER, AND SARAH MULLER

INTRODUCTION

KAMP (2001: 1) ASKED "where have all the children gone?" in reference to a lackof archaeological studies that focused on children in the past. From a bioarchaeo­logical perspective, the children have always been there and have formed an im­portant, and highly visible, portion of the data set globally (Cohen and Armelagos1984) and in Southeast Asia (Oxenham and Tayles 2006). Despite a recent in­crease in the number of volumes focusing on the archaeology of children (e.g.,Sofaer Derevenski 2000; Wileman 2005; Ardren and Hutson 2006), the emphasison mortuary studies in Southeast Asia has remained fixed on aspects of social or­ganization (e.g., Higham and Kijngam 1984; Higham and Thosarat 1998, 2004;Talbot 2002). Bacus' (2007) analysis of gender in prehistoric Thailand, and thisexamination of childhood in Viet Nam offer alternative approaches to the studyof human society in ancient Southeast Asia. Much is known of adult health anddisease in Vietnamese antiquity (Oxenham 2006; Oxenham et al. 2005, 2006),but little is known of childhood health and well-being during this period of time.Excavations of a late Neolithic cemetery in northern Viet Nam provide the op­portunity to learn more about a poorly sampled period of Vietnamese prehistoryin the context of childhood behavior, attitudes toward children, and child healthand well-being.

The aim of this paper is to: (1) examine aspects of mortuary behavior, particu­larly in terms of what this can tell us of the role of children and adult attitudestoward children in late Neolithic Man Bac, Viet Nam; and (2) discuss biologicalcharacteristics of the human sample, again focusing on the children, in order toexplore aspects of childhood palaeohealth.

Marc Oxenham, Damien Huffer, and Sarah Muller are associated with the School of Archaeologyand Anthropology at Australian National University, Canberra. Hirofumi Matsumura is affiliatedwith Sapporo Medical University, Hokkaido, Japan. Kate Domett is associated with James CookUniversity in Townsville, Australia. Nguyen Kim Thuy, Nguyen Kim Dung, and Nguyen LanCuong are researchers at the Institute of Archaeology, Hanoi, Viet Nam.

Asian Perspectives, Vol. 47, No.2 © 2008 by the University of Hawai'i Press.

OXENHAM ET AL. HEALTH AND THE EXPERIENCE OF CHILDHOOD 191

Fig. 1. View of the 2004-2005 excavation (open pit in right foreground), looking south. Man Bacis situated within a natural amphitheater of limestone outcrops. During occupation a river flowedpast the opening to this cul-de-sac in the south. Since 1999 excavations have moved progressivelywestward (to the right in the photograph).

BIO-CULTURAL CONTEXT

Man Bac is located next to Bach Lien Village, Yen Thanh Commune, Yen MoDistrict, 20°08'00/1 North and 109°59'017/1 East (Dung 2005). Man Bac wasidentified by Colani in 1916 (see Trinh 2004) and the approximately 2-m deepdeposit was excavated by a Vietnamese archaeological team in 1999 (25 m 2, 6burials), 2001 (30 m 2 , 12 burials), and then 2004-2005 (36 m 2 , 30 burials; seeFig. 1) with a consortium of Vietnamese, Japanese, and Australians. It is difficultto determine the extent of the site, primarily due to subsequent terracing and thedevelopment of a Catholic cemetery to the east of the site in the historic period,but it likely approximates 200-300 m 2

. Preliminary analyses suggest that two dis­tinct cultural phases are associated with three stratigraphic levels, the upper twounits being occupation phases and the third (bottom) layer being almost ex­clusively burials in otherwise sterile silt. Material cultural similarities between theoccupation layers and grave inclusions in the third level suggest the burials areassociated with the occupation level(s).

If the Hoabinhian, extending from the late Pleistocene into the mid-Holocene,can be considered the early Neolithic, this was followed by the development ofriverine-, estuarine-, and later, marine-oriented foraging communities in themid-Holocene of northern Viet Nam, most notably the Da But culture datedto between 6500 and 4700 B.P. (Nguyen et al. 2004). There is some tantalizing

192 ASIAN PERSPECTIVES . 47(2) . FALL 2008

evidence for Da But material culture underlying the deepest layers at Man Bac(Trinh Hoang Hiep pers. comm.), but whether this suggests some form of culturalcontinuity is unclear at present. The late Neolithic in northern Viet Nam is char­acterized by a range of regional complexes with shared and unique material cul­tural assemblages, dated to between 5000 and 4000 B.P. (Nguyen et al. 2004).Some of these sites, such as the Ha Giang culture, include items such as T -cross­sectioned nephrite bracelets; items also seen at Man Bac:

Man Bac itself formally belongs to the early Bronze Age or Phung Nguyenculture, dated to between 3800 and 3400 B.P. (Nguyen et al. 2004), althoughbronze is rare in these sites and absent at Man Bac. A series of 14C dates on char­coal (2 sigma range calibrations [INTCAL04] after Reimer et al. 2004) for theoccupation and burial layers are consistent with this: 3,341 ± 38 B.P. (1,736­1,524 B.C.); 3,393 ± 36 B.P. (1,867-1,540 B.C.); 3,530 ± 60 B.P. (2,025-1,694 B.C.).

A series of succeeding local Bronze cultures (Dong Dau 3400-3000 B.P., Go Mun3000-2700 B.P., Dong Son 2700-2000 B.P.) bring us to the annexation of theregion by the Han in the first century A.D. (Nguyen et al. 2004). Nguyen et al.(2004) relate that 50 .Phung Nguyen sites are known, many skirting the edges ofthe Red River Delta and some as large as 2000 m 2

. Before Man Bac, the largestPhung Nguyen burial assemblage was Lung Hoa, containing 12 burials, withother sites producing one or two burials at most. Pottery styles and motifs havebeen interpreted as indicating Phung Nguyen peoples maintained connectionswith surrounding coastal cultures such as the Ha Long and Hoa Loc groups; ne­phrite knives also suggest links to Shang Dynasty China (Higham 1996: 87).

In Phung Nguyen sites in general, and Man Bac specifically, an enormous arrayand variety of objects have been excavated including adzes, axes, chisels, blades,grinding stones, net sinkers, nephrite beads, bangles, rings, and ceramics. Numer­ous pottery anvils attest to the importance of local pottery manufacture, while thelithic ornaments and associated waste products support evidence for considerableskill in the manufacture of stone jewelry seen at other Phung Nguyen sites, suchas Trang Kenh (Higham 1996) . Work on the faunal remains indicates a subsis­tence base rich in terrestrial and aquatic resources and the presence of domesticpigs (Sawada and Vu 2005). Presumably some form of horticulture or agriculturewas practiced at Man Bac, although the direct floral evidence for this is currentlylacking. Long grain rice has been preserved in other Phung Nguyen sites (Nguyenet al. 2004).

As this is the first Phung Nguyen culture site with a large sample of burials tobe excavated, our knowledge of other aspects of human behaviour, including so­cial organization, is limited. However, recent work by Huffer (2005) suggestsMan Bac was characterized by limited social differentiation and was more heter­archical in structure, as opposed to hierarchical or ranked. Social differentiationwas more strongly expressed in terms of age, rather than sex or gender. The cur­rent paper will add further social and behavioral dimensions to our understandingof the Phung Nguyen period.

METHODS

Given the aims of this article, the mortuary analysis focused on both the spatialdistribution of graves and the type and relative frequency of preserved grave

OXENHAM ET AL.. HEALTH AND THE EXPERIENCE OF CHILDHOOD 193

inclusions by age. With respect to biological variables, adult sex and age-at-deathwas determined using standard osteological methods (Buikstra and Ubelaker1994), while subadults were aged predominantly through observations of thedentition (Buikstra and Ubelaker 1994; White 2000). Following age estimationthree palaeodemographic measures of mortality/fertility (which have importanthealth and population behavior implications) were calculated for the completesample: juvenile/adult ratio (JA: ratio children aged 5 to 15 years to adults 20+years old); mean childhood mortality (MCM); and D20+/D5 ratio (proportionof those living beyond 20 years to all those that made it to at least 5 years).

In order to gain insights into the health of the subadult sample three com­monly employed health indicators were assessed (e.g., see Larsen 1997; Steckeland Rose 2002). Oral health, with respect to caries, was examined as it is sensitiveto cultural (e.g., diet) and environmental (e.g., natural fluoride) variables. More­over, poor levels of oral health may contribute to reduced overall health. Cariesrecording protocols followed Hillson (2001). Two measures of physiologicalwell-being were also employed, the frequency of cribra orbitalia and enamelhypoplasia, following standard recording protocols (see Oxenham et al. 2006).The aetiology of both conditions is unclear with enamel hypoplasia, defined aspit or linear enamel deficiencies (often manifesting as grooves in the visible sur­faces of the front teeth) potentially being caused by any childhood metabolicdisruption during enamel formation (Larsen 1997). Traditionally cribra orbitalia,which manifests as either resorptive or prolific lesions in the thin bone of the up­per eye orbits in childhood, has been associated with various forms of anaemia(Stuart-Macadam 1985). It is perhaps best to see both enamel hypoplasia and

16

12

en 10«i:::J

"'0.:; 8'8.£:;,g

60

4

2

0<1 1 to 4 5 to 9 10 to 14

age class (years)

15 to 20 20+

Fig. 2. Age-specific mortality at Man Bac (all excavation seasons, n = 46).

TABLE 1. DEMOGRAPHIC ATTRIBUTES OF SEVERAL SOUTHEAST ASIAN SKELETAL ASSEMBLAGES

DATE JA D20+/(YEARS BP)l SUBSISTENCE2 <53 5-9·9 10-14.9 15-19.9 20+ RATIO D5+ MCM DR

Man Bac 3500-4000 A?/F 54.3 13.0 0.0 15.2 17.4 0.78 0.500 0.417 4.48Khok Phanom Di 3500-4000 A/F 48.1 4.5 3.2 5.2 39.0 0.20 0.750 0.091 1.30Early Non Nok Tha 4800-3400 M 27.7 4.8 2.4 2.4 62.6 0.12 0.867 0.047 1.27Early Ban Chiang 4100-2900 M 20.6 5.4 2.2 7.9 64.5 0.12 0.851 0.052 0.52Late Non Nok Tha 3400-2200 M 5.0 5.0 2.5 1.3 86.3 0.09 0.908 0.032 0.30Ban Lum Khao 3000-2500 M 32.7 10.3 4.7 4.7 47.6 0.30 0.708 0.108 1.38Late Ban Chiang 2900-1800 M 17.4 6.5 0.0 10.9 65.3 0.10 0.842 0.055 0.48Noen V-Loke 2300-1700 A/H 43.0 2.8 2.8 3.7 47.7 0.11 0.709 0.058 1.45

1 Adapted from Oxenham et al. (2006)2A: agriculture; H: horticulture; M: mixed; F: foraging/hunting

OXENHAM ET AL. . HEALTH AND THE EXPERIENCE OF CHILDHOOD 195

cribra orbitalia as generalized and for the most part nonspecific indicators of child­hood health.

RESULTS

Health Analysis

Palaeodemography - Figure 2 summarizes the age-specific mortality distribution ofMan Bac. Over 54 percent of the sample is younger than 5 years at death while33 percent are adult (> 15 years). The absence of individuals aged 10-14 yearsreflects the very low risk of death in this age category (Chamberlain 2006: 62). Acomparison with other skeletal assemblages in the region (Table 1) indicates thatMan Bac has an elevated level of sub-five-year-old mortality and an exceptionallyhigh rate of fertility as indicated by a low D20+/D5+ ratio, and relatively highjuvenile: adult (JA) and mean childhood mortality (MCM) ratios (see ]ackes 1992for a discussion of these demographic measures). A further demographic indicator,the dependency ratio, indicates a "hard life" at Man Bac with a high number ofchildren per adult.

Oral Health - Table 2 indicates that Early Childhood Caries (ECC) is elevated atMan Bac and only these children display carious lesions that cause massive crowndestruction. The two children with the most severe form of ECC had antemor­tem staining of the teeth as illustrated in Figure 3.

Physiological Health: Cribra Orbitalia and LEH - Table 3 summarizes the evidencefor cribra orbitalia in the sample. The frequency of cribra orbitalia is similar tothat seen in other samples from the region. At Khok Phanom Di, 75 percent(10/14 individuals) of subadults aged 1-14 years displayed cribrotic lesions, whilemost (7/8 individuals) aged 6-14 years had lesions. However, no (0/63) infantsyounger than one year old displayed lesions (Tayles 1999). At Ban Chiang, theoverall frequency of cribra orbitalia was 40 percent (6/15 individuals) in children7 years of age or younger, while no children (0/4) younger than 2 had lesions(Pietrusewsky and Douglas 2002).

None of the nine individuals (78 deciduous teeth) displayed enamel hypoplasia.Observations in the deciduous dentition would coincide with events during thelast five months in utero through to one year of age (Goodman et al. 1984). Like-

TABLE 2. EARLY CHILDHOOD CARIES (::;3 YEARS) EXPERIENCE INPREHISTORIC SOUTHEAST ASIA

DECIDUOUS TEETH INDIVIDUALS

SITE n OBs3 % n OBS %

Man Bac 71 6(5) 8.5 6 3 50.0Ban Na Di l 46 9(7) 19.6 4 1 25.0Ban Lum Khao I 133 3(3) 2.3 12 2 16.7Khok Phanom Di2 62 3(2) 4.8 6 2 33.3

lDomett (2001, & unpublished data); 2Tayles (1999), Sian HaIcrow pers. comm. 3Number ofaf­fected incisors/canines in parentheses

ASIAN PERSPECTIVES . 47(2) . FALL 2008

Fig. 3. Massive carious lesion toright di 1 and note also focaldemineralization of left di2

(MB05 B18, 18-month-oldinfant).

wise, no signs of enamel hypoplasia were found at Nong Nor, Ban Lum Khao,and Ban Na Di (deciduous tooth sample sizes: 86, 182, and 69, respectively;Domett 2001). While linear defects were not seen at Khok Phanom Di, Tayles(1999) recorded 7 percent, 14/200 deciduous teeth, with hypoplastic defects.

Mortuary Analysis

Burial Distribution and Orientation - Figure 4 shows the distribution of all burialsfor each of the three excavation seasons. The squares represent putative clusters,defined by way of spatial proximity to other burials. Such clusters may representgroups of related individuals that were interred beneath elevated structures. Allclusters include an adult and younger individuals. The majority of burials (95%,40/42), where position could be assessed, were extended with arms at sides. Twoburials (an adult male older than 40 and a young adult aged 15, likely male) wereflexed, and one child (possibly two) was interred in a ceramic pot. For those buri­als where an axis of orientation could be determined, 88 percent (37/42) wereplaced in an east (head) to west (feet) direction while the remaining burials wereoriented approximately north (head) to south (feet).

General Mortuary Treatment - Of the 46 individuals examined, 34 (74%) possessedsome form of grave good and 91 percent (31/34) of those had at least one ceramic

TABLE 3. FREQUENCY OF CRIBRA ORBITALIA IN MAN BAC CHILDREN:::;; IO YEARS OLD

AT DEATH

AGE n SLIGHT/MILD SEVERE ACTIVE REMODELED TOTAL%

<1 year 4 1 0 1 0 25.01 to <3 years 4 2 1 3 0 75.03 to 10 years 3 0 1 1 0 33.3total 11 3 2 5 0 45.5

2004-2005 pit (36m2)

N

2001 pit (30m2)

• .::::-:....:::::::;~t\)

1999 pit (25m2)

c=J<1 year

~.1-4years

~i15-1 0 years

~ 15-17 years

_ 18-20 years

_ 21+years

_ Unanalysed burial

D Putative burial cluster

Fig. 4. Distribution of burials by age for all excavation seasons at Man Bac.

TABLE 4. DISTRIBUTION OF MAN BAC GRAVE GOODS BY AGE-AT-DEATH

NON-CERAMIC GRAVE GOODS BY TYPEINDIVIDUALS INDIVIDUALS INDIVIDUALS

WITH GRAVE WITH WITH STONE BONE

AGE n GOODS! CERAMICS NONCERAMICS SHELL TOOL TOOL PELLET BEAD

<1 10 6/10 (60) 6/6 (100) 3/6 (50) 2/10 (20) 1/10 (10)1 to 4 15 8/15 (53) 6/8 (75) 3/8 (38) 1/15 (7) 1/15 (7) 1/15 (7) 1/7 (15)5 to 9 6 6/6 (100) 6/6 (100) 3/6 (50) 2/6 (33) 1/6 (17) 1/6 (17)10 to 14 0 0/0 (0) 0/0 (0) 0/0 (0)15 to 20 7 7/7 (100) 7/7 (100) 1/7 (14) 1/7 (14) 1/7 (14)20+ 8 7/8 (88) 6/7 (86) 4/7 (57) 2/8 (25) 1/8 (13) 1/8 (13) 1/8 (13)Total 46 34/46 (74) 31/34 (91) 14/31 (45) 7/46 (15) 4/46 (9) 2/46 (4) 3/46 (7) 2/46 (4)

! observed/n (%); shell tefers to ornaments and/or implements; pellets are clay (projectile?) balls; beads are worked nephrite

OXENHAM ET AL. . HEALTH AND THE EXPERIENCE OF CHILDHOOD 199

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

<1 1 to 4 5to 9

age class (years)

15 to 19 20+

• 3+ ceramics

.2 ceramics

III 1 ceramic

cO ceramics

Fig. 5. Frequency of ceramics per grave by age class.

object. Of all burials with ceramics, 90 percent (28/31) had at least one redwarevessel. The positioning of ceramic goods did not vary by age or sex with place­ment by the head (55.6%); torso (28.9%); between the legs (8.9%); and at the feet(6.7%). Of all individuals with grave goods, 41 percent (14/34) were interred withat least one nonceramic object and 37.5 percent of these had shell, 25 percenthad stone artifacts, and 12.5 percent had bone artifacts, clay pellets, or stonebeads.

Mortuary Treatment by Age - With one exception, all individuals ~ 5 years havesome form of grave good (Table 4). Children younger than 5 had a 50: 50 chanceof receiving a grave good. The number of ceramics placed in graves increases withincreasing age-at-death (Fig. 5). An exception to this trend is seen in burial 3 (six­month-old infant, Fig. 6) that was interred with two small redware pots and a claypellet. Three other children, aged between 7 and 10 years, also possessed twoceramICS.

Shell was found in all age classes except one (15-20 years), tools (bone andstone) were not found with very young children, and only children younger than5 years and a single adult male aged approximately 20 years had clay pellets (Table4). Nephrite beads were only found with young children and mature adults. An8-year-old child is unique (Fig. 7) in being the only individual to have what maybe "shell knives" (large elongated bivalve shells) and be actively engaging with agrave good (grasping these "knives"). With the exception of two mature adults,this child has the "richest" grave in terms of the number and variety of materialculture.

Only children received some form of obvious encasement or grave demarca­tion and this was rare: one clear stone circle (18-month-old infant), one probabledeliberate multiple stone placement (less than 12-month-old infant), and one potburial (approximately 2-year-old child).

Fig. 6. Six-month-old infant (MBOS BOS) with two small pots. (Photo courtesy of Lorna Tilley)

Fig. 7. The eight- to nine-year-old "shell child" (MBOS B2S) grasping large bivalve shells. (photocourtesy of Lorna Tilley)

OXENHAM ET AL. . HEALTH AND THE EXPERIENCE OF CHILDHOOD 201

DISCUSSION

Health

Early childhood caries (ECC), referred to as nursing-bottle or baby-bottle caries,rampant caries, and labial caries (Slavkin 1999), was an important health issue atMan Bac. The risk of developing ECC is greatly increased with increased levelsof mutans streptococci (Milgrom et al. 2000; Thorild et al. 2002). While cario­genic bacteria can readily be transmitted from mother to child (Caufield et al.1993), the successful transmission and subsequent colonization of the child's oralcavity by these organisms is complex and ultimately related to a number of factorsreliant on diet (Boggess and Edelstein 2006). A recent study in Myanmar foundan increased risk of ECC associated with children that had been fed pre­masticated rice by their mothers (van Palenstein Hilderman et al. 2006).

Fluoride is a well-known caries prophylactic (Leverett 1982) and high rates ofcaries have been associated with low levels of fluoride in the groundwater (e.g.,Sealy et al. 1992). The ground water fluoride levels are not known for Man Bacand neither is it known if this community relied on groundwater or rainwater,as is common in modern rural communities in Thailand (Vachirarojpisan et al.2004). Other studies of prehistoric populations (Kelley et al. 1991; Larsen et al.1991) have reported the cariostatic nature of marine diets. However, Man Bacinfants as young as two years old may not have consumed the portions of a ma­rine diet that contain stored fluoride (the bones of fish).

Breast-feeding may increase the risk of ECC, although a recent review of theliterature disputes this (Ribeiro and Ribeiro 2004). While human breast milk hasa very low cariogenecity, prolonged breast-feeding, in conjunction with night­time feeding, has been linked to an increased risk of developing ECC in one Bur­mese study (van Palenstein Helderman et al. 2006).

Levels of oral hygiene also have an effect on the risk of developing ECC, butare difficult to isolate from other factors such as feeding habits and developmentof the child's immune system (Seow 1998). The staining of the teeth of the mostseverely affected children resembles the effects of Vietnamese betel nut (Areca cate­chu) use (Oxenham et al. 2002). Betel nut was used for a vast range of medicalconditions (Perry 1980: 302), which may have included feeding infants with ex­tremely painful massive carious lesions the juice of premasticated Areca catechu.

A further factor is increased risk of ECC through predisposing conditions suchas deciduous tooth enamel hypoplasia or hypocalcifications (Cook and Buikstra1979). In the case of the two infants with severe lesions, the massive crown de­struction may have disguised the presence of hypoplastic lesions.

The rates of cribra orbitalia in children are similar to those seen in children atBan Chiang and Khok Phanom Di and suggest the nonsurviving children inSoutheast Asia were under considerable physiological stress at the time of death.Cribra orbitalia is often associated with anaemia (e.g., Stuart-Macadam 1985), arange of inflammatory conditions (e.g., Wapler et al. 2004), or scurvy (e.g., Ort­ner et al. 1999). The two most severe cases of cribra orbitalia were associated withthe two infants with the most severe carious lesions. The synergistic effects of thedisease conditions responsible for ECC and cribra orbitalia in these two childrenmay have played a role in their eventual deaths.

202 ASIAN PERSPECTIVES . 47(2) . FALL 2008

The high proportion of subadults in the sample influences the palaeodemo­graphic indicators in suggesting very high levels of fertility at Man Bac. Compet­ing reasons for apparently high subadult mortality include sampling bias, an epi­demic or disease that targeted children at Man Bac, or a culturally mediated formof infant mortality such as infanticide. Sampling bias seems unlikely given thatchildren, even the very young, do not appear to have been buried in separatelocations and skeletal preservation was excellent at the site. Epidemics andincreased childhood mortality due to some unknown disease factor cannot betested at present. An epidemic scenario, at least, does not appear to be consistentwith the time and energy spent on child burials. However, the observation thatapproximately half of the burials of children 5 years of age or younger do notpossess grave goods could be interpreted as lowered mortuary investment in ahigh risk-of-death age class.

Infanticide is more often the rule, rather than the exception (Williamson1978: 61). Scrimshaw (1984) distinguishes between more overt forms of infanti­cide (deliberate killing) and more passive forms (including a range of infant ne­glect strategies that can take years to reach a conclusion). While the latter wouldbe very difficult to observe archaeologically, the more overt type "almost alwaysoccurs at birth or very shortly thereafter" (Scrimshaw 1984: 449). Given that onlya single neonate has been recovered from Man Bac, the overt form of infanticideis unlikely. '

High rates of infant mortality at Man Bac say more about fertility than sam­pling error, epidemics, or infanticide. Increasing levels of fertility are seen inmany sites around the globe with the adoption of agricultural subsistence econo­mies (e.g., Bocquet-Appel and Naji 2006). While there is no direct evidence forrice agriculture at Man Bac, long-grain rice has been recovered from other PhungNguyen sites (Nguyen et al. 2004). The high rate of fertility at Man Bac was per­haps tempered by an extremely high dependency ratio, which suggests a ratherdifficult life. However, in many agricultural societies children are cared for byother children (Zeller 1987), thus freeing the time of parents and other adultcaregivers for other tasks. The costs associated with more children may not havebeen that great at Man Bac, and the benefits in terms of the economic contribu­tion of the children may have tipped the balance in favor of higher fertility. "Insuch a young population children could be raised in a world of children, takecare of other children and contribute to society through child labour" (Lilleham­mer 2000: 23).

Mortuary

Carr (1995: 165) found intracemetery grave location is often reflective of kinrelations. The apparent clustering of inhumations as well as the observation thatat least one adult and a range of younger age categories form these clusters, sug­gests family groupings, perhaps beneath domestic, mortuary, or other structures.Three basic aspects of mortuary treatment at Man Bac include: (1) the orientationof the body (generally head to the east and feet to the west); (2) supine burialswith arms at sides for the most part; and (3) the inclusion of the default gravegood, a ceramic that was often in the form of a redware pot. Body orientationand positioning are often associated with philosophical and/or religious beliefs

OXENHAM ET AL. . HEALTH AND THE EXPERIENCE OF CHILDHOOD 203

(Carr 1995). The ubiquity of pottery may also have a more fundamental eschato­logical meaning as well.

The number of ceramic objects and other, nonceramic, material culture wereperhaps used to denote aspects of identity. Some females and some children wereinterred with similar types of objects, particularly shell ornaments and apparentimplements (nephrite adzes and bone tools for instance), while nephrite beadsand clay pellets are found in the graves of children and an apparently high-statusmale. If it is accepted that modes of production are generally passed on alonggender lines in small-scale societies (Goody 1989; Grimm 2000), it may be thatfemales controlled both the economic activities, and the reproduction or trans­mission of associated skill sets, associated with nephrite adzes, bone implements,and shell ornaments (and perhaps shell implements) at Man Bac.

The association between clay pellets and a high-status male and two children isambiguous. The small (approximately 1-cm diameter) spherical clay pellets wereubiquitous in the upper layers and have been excavated in many other sites inprehistoric Thailand and are used as projectiles in a bamboo bow for hunting(Higham and Kijngam 1984, I: 197). The jar burial child was too disturbed to de­termine exactly how the pellet related to the rest of the material culture. With theother child, aged 18 months, the pellet was associated with broken pottery.Crawford (2000) has recounted several Anglo-Saxon examples of possible rattleswhere children were interred with pots containing nails or stones. It is worthconsidering the types of objects children may collect or use in play and Crawford(2000: 174) notes "that where Anglo-Saxon children do use material objects asthe focus of play, these items are requisitioned from their environment or fromthe adult world."

One of the most interesting burials is the shell child. Carr (1995: 174) notesthere is a shift from personal identity to social categories in mortuary treatmentwith increases in sociopolitical complexity. The mortuary treatment of the shell­child may be more an expression of important aspects of the child's identity thananything else. No other interment displayed active engagement with a piece ofmaterial culture. Without exception, material culture was positioned by or onthe body in a passive manner (adze placed on the chest or pot placed betweenthe legs for instance).

Why was this child singled out for such treatment? What is this staged engage­ment with these "knives" supposed to represent? Minimally, the shell child was anactive social and perhaps economic agent in this community. Children clearlyparticipate "in social and economic life" (Sofaer Derevenski 2000: 11) and are notsimply passive and dependent consumers. Substantive economic contributions canbegin as early as 3 years of age, although the period between 6 and 10 yearsappears to be more common (Zeller 1987). An 8- to 9-year-old child might con­ceivably be seen as an accomplished craftsperson, if aspects of his/her economicprowess are being observed here.

Both gender and vertical social position can be signified by the type of gravefurnishing (see Carr 1995: 169), although artifact type and quantity are weaklyassociated with vertical rank (Carr 1995). That this interment is unique may bereason enough to see the child as having some form of exceptional status in thecommunity, or within her/his family at least, while the presence of so much shellsuggests the child may have been female. Whether such an individual was still a

2°4 ASIAN PERSPECTIVES . 47(2) . FALL 2008

child is difficult to assess. In seventh-century Anglo-Saxon Britain, for instance,children were legally adult at 10 years old (Crawford 1991).

Children's graves are characterized by the exclusion and inclusion of a range ofobjects, some shared with adult females. The lack of non-perishable grave goodswith many children aged younger than 2 suggests an important threshold or socialmilestone once a child turns 2 years of age. Nonetheless, very young infants couldbe afforded potentially specially produced miniaturized ceramics as grave furnish­ings and only young children, albeit rarely, received any clear form of graveboundaries. Such children could be interpreted in the context of ascribed status,but this seems unlikely as the only reasonably clear form of vertical differentiationseen at Man Bac is age-based. Overcompensated parental grief is often the com­peting alternative (e.g., see Parker Pearson 1999:77-78), but is impossible to ver­ify. Both social and philosophical/religious factors are commonly associated withformal grave demarcation (Carr 1995). In lieu of any other evidence suggestingthe presence of anything other than age-based vertical differentiation, formalgrave demarcation may be speaking to aspects of the eschatology of the Man Baccommunity.

The reasons for the increased energy expenditure in some children's graves andminimal mortuary treatment in others are unclear. Nonetheless, it is clear thatchildren of all ages were recognized as worthy of mortuary ritual and thus argu­ably recognized as individuals, people, or at least members of the community. Inwhat is otherwise a relatively egalitarian community, differential mortuary behav­ior may be indicative of choice in individual mortuary treatment open to parentsand/or carers of deceased children. As long as certain conventions were main­tained, relatives of dead children may have had considerable flexibility in whatwas interred, if anything at all, with their young.

CONCLUSIONS

The aim of this article was to explore aspects of how children were perceivedsome 3500 years ago in Viet Nam and also to examine facets of the health ofthese same children. Interpretations of the health of the children must be tem­pered by the observation that we are looking at the children who didn't make itinto adulthood. Physiological insult manifesting as cribra orbitalia was a serioushealth risk associated with childhood at all ages, while the lack of deciduousenamel hypoplasia perhaps indicates some forms of physiological insult were notoccurring until after the first year of life. One of the greatest specific health riskswas in the form of early childhood caries. While aetiologically complex, in someindividual cases extreme forms of ECC and active cribra orbitalia no doubt con­tributed to poor health, and perhaps even early death. Many of the children ofMan Bac seem to have experienced suboptimal levels of well-being.

The large number of children at Man Bac has been interpreted as suggestinghigh levels of fertility, which is consistent with a community either transitioninginto an agricultural mode of subsistence or intensifying their agricultural base.The costs associated with caring for the extra number of children alive at anygiven time in this community was likely offset by the economic contributions ofthese children. It is likely that children at Man Bac were raised in a community ofmany other children who both cared for and took care of each other.

OXENHAM ET AL. . HEALTH AND THE EXPERIENCE OF CHILDHOOD 205

In terms of attitudes toward children, everyone received some form of basicmortuary treatment regardless of age. That everyone buried at Man Bac had ac­cess to such rights, and that some children (as young as six months old) receivedspecial treatment suggests that children had value or at least were worthy of rec­ognition: in other words, children were also people. While all children receivedsome form of mortuary treatment, by their second year they all received someform of nonperishable material culture. This may be indicative of a special socialand/or developmental milestone in childhood.

In terms of gender, adult females and some children could share certain formsof material culture, especially shell. Whether this means that children were seenas having gender is difficult to determine. Some children may have received"female" grave inclusions because they were themselves female, or simply becausethey were not perceived of as having gender and could thus be buried with arange of otherwise adult gender-specific material culture. Perhaps more importantis that some of the artifacts interred with children have economic connotationsand suggest that children had an economic role in the community. The case ofthe shell child is also suggestive of both economic value and a further social and/or developmental stage: it may well be that childhood finished rather early at ManBac.

In summary, many of the nonsurviving children of Man Bac had demonstra­bly suboptimal health prior to their eventual death. The high level of fertilitysuggests many children were alive in the community at any given time. Many ofthese children were likely economic and certainly social contributors to the com­munity. Mortuary treatment of children reflects the esteem in which they wereheld and also, in some cases, certain life stages through which they passed.

ACKNOWLEDGMENTS

The authors would like to thank Sian Halcrow, University of Otago, for providingcomparative data on childhood oral health in prehistoric Thailand, and Lorna Til­ley, Australian National University, for providing access to photographic material.Part of this research was made possible by way of a Grant-in-Aid from the JapanSociety for the Promotion of Science (No. 15405018), a Toyota Foundation Grant(D006-R-35), and a National Australian University FRGS (2004/2005) Grant.

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ABSTRACT

The article aims to examine aspects of mortuary behavior in late Neolithic/earlyBronze Age (Phung Nguyen phase) populations represented at the site of Man Bacin Viet Nam, specifically how mortuary behavior illuminates the role of children,and adult attitudes toward children. In addition, the authors discuss biological char­acteristics of the human sample, focusing particularly on the child burials, in orderto. explore aspects of childhood palaeohealth. The methodology includes combiningvarious measures of health-including palaeodemography (childhood mortality),analysis of oral health (Early Childhood Caries or ECC), and analysis of physiologi­cal health (Cribra Orbitalia and LEH)-with studies of culturally defined mortuarypractices to suggest that, while children clearly had significant health deficienciesand many suffered early deaths, their treatment in mortuary rites shows significanteconomic value and social esteem placed on children. KEYWORDS: Viet Nam, Neo­lithic, childhood, health, mortuary behavior, palaeodemography, bioarchaeology.